We can´t be sure that words will save, but we know full well that silence kills!
Stories of a Doctor working in places, where humanitarian issues make "our problems" in life a bit smaller.... It wound be easier to close my eyes, but I decided to open them and share with the world what I have lived.

segunda-feira, 18 de janeiro de 2010

O Aperto de Mão (english version) - The Hand Shake

Here I
start, telling you my first story of many, that could be told about my mission
in Congo, where I worked as a doctor anesthesiologist, for the Doctors Without
Borders (Medecins Sans Frontiers), in a region called North Kivu, in a town
called Masisi, close to the border of Rwanda, a very complicated region, that
it has been innocently punished by a horrible war, that insists on going on,
and it has murdered in the last 15 years about 5 million people... And as
always the ones who suffer the most are the innocent civilians, women,
children… whose destiny wanted them to be born in one of the worst zones of the
planet to live in. But the will to live, to smile, to love, to have children
and all that characterizes the magic of the human being is present in these
people that have a lot of will to live and give life!

And here
it goes a story, that for me proves that very well....

In the
place where I was working, as many others in Africa, one of the most common
surgeries that we performed was the C-section, given the high natality rate,
for many different indications many times we were called to operate so we could
save the mother, the baby or both. As many other times I was called to the
operation room in the middle of the night, tired of many days of hard work
almost with no breaks.... I made a spinal anesthesia, or for the ones not in
the medical field, I stuck a needle in the patient’s back in order to
anesthetize all the inferior part of the body below the umbilicus, meaning that
the future mother was awake seeing and listening all she could.... Because of
the lack of monitorization of the fetus, it happened what happened many times
in that hospital..... I had to do reanimation of the newborn.... Once again
explaining the non-medical, the fetus was suffering inside the uterus, and the
C-section came already late …. lucky or not I was there.... With some training
about these issues, but not so much practice because it’s quite rare to be
necessary in our hospitals in the developed world...

This
newborn needed active reanimation, due to the intra-uterus suffering, to help
him in this period that for some is so difficult or even fatal, that is the
first time we breath.... Normally a simple tactile stimulation is enough to
give that little push to the baby, but for some it’s necessary bag-mask
ventilation, and when it’s not effective, we have sings that the oxygenation is
not enough, the heart rate keeps on going down, which can cause permanent
damage of the brain of the newborn caused by the lack of oxygen that reach the
brain cells…. and very fast.... because all this is made in seconds or few
minutes of tough decisions and actions, its necessary to improve the
oxygenation by placing a tube through the mouth to the trachea.... performing
the act that characterizes the Anesthesiologist so much …

What you
see in this picture is the end of those stressful moments, that fortunately had
an happy ending which you can see by the pink color of the skin and lips of
this baby.... my hand seems to be giant next the this very new Congolese... a
stethoscope... that I used to evaluate the ventilation of this little fellow,
it’s for an adult, but there was not a pediatric one.... but even worst to whom
is somehow aware of the medical world, is the size of the blade of the laryngoscope
(but it was this one that I had to use adapting to what it was available).... this
metallic device that you see in the right upper corner of the picture that is
used for the direct visualization of the larynx and the trachea, to introduce
the tube in the trachea, allowing a much more effective ventilation and
oxygenation that might have saved the life of this baby..... As I said this
story as an happy ending.....the newborn breaths without my help or any tube
and full of energy to contribute one day for a better Congo, I hope ….maybe I
am dreaming to much....but one of the lessons that I have learned and
reinforced every day is that we always need to think positive as hard as we can!!

Calm down, this is not the end of this story.... All of these minutes of
reanimation of the newborn, where the speed of my performance, easily shows
some stress that I went through, so everything would go well, and where the
mother (that was awake) saw all my will to make this baby to cry out loud, as
we all like to hear in those where you just cut the umbilical cord....

I can only imagine, what a mother thinks lying down in a stretcher, with half
the body paralyzed, with a sheet preventing her from seeing the surgery, but
she could but flexing her neck to the left watch during few but probably long
minutes, this strange white man coming god knows from where, during the night
putting so much effort so that her son would be born healthy in this zone of
the planet that seems to be forgotten by the rest of the world.... Unfortunately
the language barrier prevents me from knowing what was passing by this woman’s
mind, that unlucky for some reasons was lucky enough to have a hospital of the
doctors without borders in that area of an ugly war....

When I am sure that the baby is far from danger, I turn my attention back to
the mother, and because the verbal communication was impossible (because I
didn't speak Swahili), as many other times I had to use other ways of
communicating with my patients and so I passed my hand by the hair and forehead
smiling and passing the message that everything was alright, and danger was far
from her sweet little baby.... it was in that moment that she said to me some
words that I didn’t understand! She stretched her arm towards me and I still didn’t
understand!! Until a Congolese nurse (translating Swahili to French) told me:
“She wants to shake your hand, Doctor!” And so it was, shaking my hand and
staring at me with truth and honesty, in this deep black look, that she told
me: “Asante Sana!” – “ Thank you very much!”

And this
Hand Shake is one of the reasons why I took risks that I didn’t need to take,
crossed the world because I wanted to, and much worst I made suffer many that I
like that I left behind with the heart beating fast, suffering with no need to
suffer….

For all
of those, I am sorry, this is my way of saying thank you and explaining you why
….